Ethical Dilemmas in the Intensive Care Unit Treating Pain and Symptoms in Noncommunicative Patients at End of Life

A large percentage of patient deaths occur during or shortly after an intensive care unit admission. Death and dying is not a new phenomenon occurring in these units; the very nature of this level of care is that patients are at their sickest and most acute phases of illness. The difference lies with advances in medical technology and pharmacologic therapies that have the potential to extend life but also fuel the fire of an already death-denying culture. As critical care teams are confronted with the increasing demands of this patient population, ethics and palliative care consultants are being called upon to assist with frequently encountered ethical and moral dilemmas. A case is presented that highlights 2 common ethical challenges seen in the intensive care unit: symptom management in the noncommunicative patient and medical futility. Steps to address concerns of nurses and outcomes are discussed.